Social mobilization for sanitation in Orissa, India

Last registered on February 17, 2021

Pre-Trial

Trial Information

General Information

Title
Social mobilization for sanitation in Orissa, India
RCT ID
AEARCTR-0006715
Initial registration date
February 16, 2021

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
February 17, 2021, 10:36 AM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Region

Primary Investigator

Affiliation
Duke University

Other Primary Investigator(s)

Additional Trial Information

Status
Completed
Start date
2005-06-01
End date
2006-09-30
Secondary IDs
Abstract
This experimental study aimed to determine the effectiveness of a social mobilization campaign to promote sanitation in rural Orissa. Using a cluster-randomized design, we selected 20 treatment and 20 control villages in the coastal district of Bhadrak, rural Orissa, for a total sample of 1050 households. We collected sanitation data before and after a community-led sanitation project, and we used a difference-in-difference estimator to determine the extent to which the campaign influenced the number of households building and using a latrine. The results indicate that latrine ownership did not increase in control villages, but in treatment villages, it rose from 6% to 32% in the overall sample, from 5% to 36% in households below the poverty line (eligible for a government subsidy) and from 7% to 26% in households above the poverty line (not eligible for a government subsidy). These results suggest that subsidies can overcome serious budget constraints but are not necessary to spur action, for shaming can be very effective by harnessing the power of social pressure and peer monitoring.

Registration Citation

Citation
Pattanayak, Subhrendu. 2021. "Social mobilization for sanitation in Orissa, India." AEA RCT Registry. February 17. https://doi.org/10.1257/rct.6715
Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2006-02-01
Intervention End Date
2006-05-31

Primary Outcomes

Primary Outcomes (end points)
Adoption of improved household latrines
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Child health. Self-reported diarrhea, child anthropometrics (height, weight, mid-arm circumference)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Experimental Design (Public): [In public domain]
We applied a cluster randomized design to assess the effect of the intensified IEC campaign on latrine adoption in two selected blocks of Bhadrak district in Orissa. This was felt to be the best experimental design because social mobilization is essentially an attempt to achieve group consensus and move social norms by targeting entire communities, not just individuals.

Based on Community Led Total Sanitation (CLTS) approach in many parts of rural Asia, project team developed an intensified information, education and communication (IEC) campaign. This approach was further informed by in-depth interviews and focus groups with state and local government officials, village residents and key informants. The interviews revealed the importance of social marketing tools must go beyond merely providing "information" on health and in addition, focus on education and communication about the need for a strong, sustained and widely-accepted commitment to improve sanitation. Our discussions showed that it was critical to secure the support of district administrators, public health engineers and nongovernmental organizations (NGOs), as well as to train government civil engineers in social engineering. These preparation activities also suggested that any effective IEC effort must look beyond health to the privacy, dignity and safety benefits to women from using latrines. By changing knowledge, attitudes and practices (the "software"), rather than simply providing a latrine (the "hardware"), the community-led total sanitation approach empowers local people to analyze the magnitude and risk of the environmental pollution caused by open defecation. Examples of social mobilization in treatment villages include: a "walk of shame" (the main consciousness-raising exercise), defecation mapping and core feacal counts. The first was primarily comprised of a community walk aimed at drawing attention to poor hygiene and triggering a collective emotional response. The second invovled a set of participatory exercises that sought to identify the spatial distribution of defecation behaviours and to demonstrate the external effects of poor hygiene on the entire village. The third, which also serves to explain external consequences, involves determining and discussing the volume of faecal matter accumulated in a village. Subsidies were not randomly assigned. Rather, they were available only to poor households because the campaign was implemented within the framework of the Government of India's nationwide Total Sanitation Campaign, which recognizes that income constrains many households in rural areas. Constructing the off-pit latrines promoted under this campaign was prohibitively costly at about 2000 rupees (Rs) per laterine (equal to about 50 US$). Thus, following Total Sanitation Campaign policies, households below the poverty line (with a monthly per capita consumption expenditure of Rs 356) were only required to pay Rs 300 (or US$ 7.5) to build a latrine, whereas other households had to pay the full price. In each of 20 intervention villages, the intervention typically lasted between 1 to 2 weeks; the entire campaign lasted between February and April 2006. To ensure that social mobilization was conducted with sensitivity to local customs, in each village a local community-based organization – which had a prior agreement with state Water and Sanitation Mission - helped with implementation of the intervention, including establishing sanitation marts, procuring latrine components for the village and provide know-how on latrine engineering. A similar mobilization protocol was followed across the 20 intervention villages to achieve the same goal: a community able to analyze its sanitation situation and agree to end open defecation.
Experimental Design Details
Randomization Method
Names of each of 40 eligible villages were written on separate cards and placed in a covered urn. In a town hall meeting, a local official (not involved in the implementation) randomly drew cards from the urn to select 20 intervention villages. This was followed by a listing and mapping stage, in which survey team members listed all households having at least one child less than 5 years of age in each of the 40 villages. From this listing, a simple random subset of 28 households were chosen by a survey manager who was not on the mapping teams. Thus, neither the implementers nor the survey respondents influenced the selection of villages or households. Furthermore, the enumerators collecting the data were blinded to the intervention status of the villages.
Randomization Unit
Village
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
40 villages
Sample size: planned number of observations
1080 Households
Sample size (or number of clusters) by treatment arms
20 villages control, 20 villages IEC campaign
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
RTI
IRB Approval Date
2005-02-08
IRB Approval Number
A09073

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Abstract
Objective: To evaluate the long-term impact of a community-led total sanitation campaign in rural India.
Methods: Local organizations in Odisha state, India worked with researchers to evaluate a community-led total sanitation campaign, which aimed to increase the demand for household latrines by raising awareness of the social costs of poor sanitation. The intervention ran from February to March 2006 in 20 randomly-selected villages and 20 control villages. Within sampled villages, we surveyed a random subset of households (around 28 households per village) at baseline in 2005 and over the subsequent 10-year period. We analysed changes in latrine ownership, latrine functionality and open defecation among approximately 1000 households. We estimated linear probability models that examined differences between households in intervention and control villages in 2006, 2010 and 2016.
Findings: In 2010, 4 years after the intervention, ownership of latrines was significantly higher (29.3 percentage points; 95% confidence interval, CI: 17.5 to 41.2) and open defecation was significantly lower (−6.8 percentage points; 95% CI: −13.1 to −1.0) among households in intervention villages, relative to controls. In 2016, intervention households continued to have higher rates of ever owning a latrine (26.3 percentage points; 95% CI: 20.9 to 31.8). However, latrine functionality and open defecation were no longer different across groups, due to both acquisition of latrines by control households and abandonment and deterioration of latrines in intervention homes.
Conclusion: Future research should investigate how to maintain and rehabilitate latrines and how to sustain long-term behaviour change
Citation
Orgill-Meyer, J., Pattanayak, S. K., Chindarkar, N., Dickinson, K. L., Panda, U., Rai, S., ... & Jeuland, M. (2019). Long-term impact of a community-led sanitation campaign in India, 2005–2016. Bulletin of the World Health Organization, 97(8), 523.
Abstract
Worldwide, over 2.5 billion people lack access to basic sanitation, a situation that contributes to 2 million annual diarrhea-related child deaths and substantial morbidity. Yet rigorous evaluations of sanitation behaviors and their health and welfare impacts are rare. This article uses a randomized sanitation promotion campaign in Orissa, India, to evaluate child health and household welfare outcomes. The sanitation campaign increased households’ ownership and use of latrines and improved children’s mid-upper-arm circumference, height, and weight z-scores. Switching from open defecation to latrine use also saved time and increased satisfaction in sanitation conditions. We use our results to illustrate the cost-benefit calculus underlying this seemingly unglamorous and mundane household choice with potentially large environmental externalities.
Citation
Dickinson, KL, SR Patil, SK Pattanayak, C. Poulos and JC Yang. 2015. “Nature’s Call: Health impacts of sanitation choices in Orissa, India.” Economic Development and Cultural Change. 64(1): 1-29.
Abstract
OBJECTIVE: To determine the effectiveness of a sanitation campaign that combines "shaming" (i.e. emotional motivators) with subsidies for poor households in rural Orissa, an Indian state with a disproportionately high share of India's child mortality.
METHODS: Using a cluster-randomized design, we selected 20 treatment and 20 control villages in the coastal district of Bhadrak, rural Orissa, for a total sample of 1050 households. We collected sanitation and health data before and after a community-led sanitation project, and we used a difference-in-difference estimator to determine the extent to which the campaign influenced the number of households building and using a latrine.
FINDINGS: Latrine ownership did not increase in control villages, but in treatment villages it rose from 6% to 32% in the overall sample, from 5% to 36% in households below the poverty line (eligible for a government subsidy) and from 7% to 26% in households above the poverty line (not eligible for a government subsidy).
CONCLUSION: Subsidies can overcome serious budget constraints but are not necessary to spur action, for shaming can be very effective by harnessing the power of social pressure and peer monitoring. Through a combination of shaming and subsidies, social marketing can improve sanitation worldwide.
Citation
Pattanayak, S. K., Yang, J. C., Dickinson, K. L., Poulos, C., Patil, S. R., Mallick, R. K., ... & Praharaj, P. (2009). Shame or subsidy revisited: social mobilization for sanitation in Orissa, India. Bulletin of the World Health Organization, 87, 580-587.

Reports & Other Materials